Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report

Dhanalakshmi Angappan, McKinnon Garrett, Candice Henry, Art Riddle, Jenny L. Wilson

Research output: Contribution to journalArticlepeer-review


Thoracic outlet syndrome (TOS) is a condition that results from the compression of neu-rovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention.

Original languageEnglish (US)
Article number875
Issue number6
StatePublished - Jun 2022


  • endovascular treatment
  • ischemic stroke
  • pediatric stroke
  • thoracic outlet syndrome
  • thrombectomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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